Here is the case for week 9 SOAP note. As with prior assignments, please answer the questions at the end of the SOAP note. Make sure to outline your specific plans in your SOAP note.

Marcia is a 28 year old female who comes in with a complaint of nipple drainage. She says that the discharge started about three months ago and it appears milky. She says that she has also felt tired, and has been constipated lately. Her periods have been very light. She is worried that she “might have cancer”.

1. What are the three classifications of nipple discharge?
2. Based on the above description, what classification does this fit into?
3. Aside from the above concerns, name three other things this woman may be experiencing.
4. Women with a strong family history of breast cancer may be candidates for genetic testing for __________ mutations.
5. You do a thorough breast examination on this pt. What are two important components of this exam on anyone with nipple drainage?
6. You do a complete medication history as well as elicit past medical history, including endocrine and reproductive history. What are four important parts of the exam on this pt and why?
7. Name five chemical agents that can cause nipple discharge and galactorrhea.
8. What should the nipple discharge be tested for?
9. Why are cytologic studies not recommended?
10. Should diagnostic mammography be performed?
11. Following diagnostic mammography, what other imaging study might be performed and why?
12. What are two important lab tests to obtain?
13. When would an MRI of the brain be indicated?
14. Name three possible diagnoses for this patient.
15. If galactorrhea is suspected due as a result of a chemical origin, what must be done?
16. Galactorrhea is more common in _____________ (premenopausal/postmenopausal) women.
17. All patients with spontaneous or unilateral nipple discharge regardless of color, should be referred for surgical evaluation.
18. Patients should be educated that most causes of breast discharge are malignant.
19. In women with galactorrhea, where the prolactin level is normal and menses are normal, women should be informed of the normal physiologic association with ______________________.
20. Why is nipple discharge so concerning to most women?